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      Targeted mentoring for human immunodeficiency virus programme support in South Africa

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          Abstract

          Background

          Mentoring is a required component of health systems strengthening technical assistance interventions in low- and middle-income countries (LMICs). Mentoring is useful because it does not necessarily compromise service delivery and promotes the sharing of newly acquired knowledge and skills. However, there is a lack of research on the implementation of mentoring in the context of the HIV epidemic in southern Africa.

          Objectives

          This qualitative evaluation focussed on understanding the implementation process of targeted mentoring for clinical practice, data management and pharmacy management, at public health care facilities in South Africa; and on identifying critical factors influencing the effectiveness of mentoring as a technical assistance intervention in this context.

          Methods

          Purposive sampling was used to select participants from public health facilities in three South African Provinces. Participants were invited to take part in structured interviews. Datawere analysed using thematic analysis, and two core themes were identified: mentoring as knowledge and skills transfer; and mentoring as psychosocial support.

          Results

          In terms of knowledge and skills transfer, the sequential implementation of proactive and reactive mentoring was critical. Initial proactive mentoring involved mentors initiating training and developing professional relationships with mentees. Thereafter, a reactive mentoring phase allowed mentees to request support when required. This enabled mentors to leverage real-world problems faced by health workers to support their implementation of new knowledge and skills. The availability and accessibility of mentors alongside the relationships between mentors and mentees provided psychosocial support for health care workers which facilitated their self-efficacy in implementing new knowledge and skills.

          Conclusion

          These findings suggest that the success of mentoring programmes in LMICs may require specific attention to both knowledge transfer and the management of interpersonal relationships.

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          Most cited references 17

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          Does Mentoring Matter? A Multidisciplinary Meta-Analysis Comparing Mentored and Non-Mentored Individuals.

          The study of mentoring has generally been conducted within disciplinary silos with a specific type of mentoring relationship as a focus. The purpose of this article is to quantitatively review the three major areas of mentoring research (youth, academic, workplace) to determine the overall effect size associated with mentoring outcomes for protégés. We also explored whether the relationship between mentoring and protégé outcomes varied by the type of mentoring relationship (youth, academic, workplace). Results demonstrate that mentoring is associated with a wide range of favorable behavioral, attitudinal, health-related, relational, motivational, and career outcomes, although the effect size is generally small. Some differences were also found across type of mentoring. Generally, larger effect sizes were detected for academic and workplace mentoring compared to youth mentoring. Implications for future research, theory, and applied practice are provided.
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            Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia

            The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.
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              Using thematic analysis in psychology

               V. BRAUN,  V Clarke,  V Braun (2006)
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                Author and article information

                Journal
                South Afr J HIV Med
                South Afr J HIV Med
                HIVMED
                Southern African Journal of HIV Medicine
                AOSIS
                1608-9693
                2078-6751
                14 February 2019
                2019
                : 20
                : 1
                Affiliations
                [1 ]Anova Health Institute, South Africa
                [2 ]School of Public Health and Family Medicine, University of Cape Town, South Africa
                [3 ]Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, South Africa
                Author notes
                Corresponding author: Geoffrey Jobson, geoffjobson@ 123456gmail.com
                Article
                HIVMED-20-873
                10.4102/sajhivmed.v20i1.873
                6407314
                © 2019. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                Categories
                Original Research

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